Helicopter rescue involving the winching of a physician

1855 missions de secours héliportés impliquant le treuillage d'un médecin ont été répertoriées. L'étude de la gravité des blessures ainsi que les difficultés pour accéder au patient ont permis de répondre à la question de la pertinence de ces procédures. Enjeu L'utilisation d'hélicoptères dans un système extra-hospitalier ainsi que la médicalisation de ces derniers est controversée. Des problèmes liés au coût, à la sécurité ainsi qu'à l'efficacité ont été évoqués. Les critères d'engagement sont également régulièrement remis en cause. Aucune étude récente ne s'est intéressée à la pertinence du système suisse et c'était un des objectifs de ce travail. Contexte L'étude s'est intéressée à tous les patients pris en charge par les médecins de la base Rega de Lausanne pendant une durée de 4 ans Conclusions Le treuillage héliporté est nécessaire pour un nombre significatif de patients. La gravité des diagnostics et le nombre de procédures médicales avancées justifient la médicalisation ainsi que le treuillage en raison des difficultés d'accès et d'évacuation. Perspectives Cette étude permet de répondre à l'utilité de la médicalisation en terrain difficile pour la région étudiée. Toutefois ces résultats ne devraient pas être extrapolés à d'autres régions ni à d'autres pays. Des études similaires sont nécessaires afin de permettre une comparaison internationale des différents services de secours héliportés

Urgences vitales au cabinet médical: implications pour la formation et l'equipement du médecin de premier recours [Life-threatening emergencies at the office: implications for medical education and equipment of the primary care physician].

Every medical practitioner is confronted on a daily basis with emergencies. Among these, life-threatening emergencies can have disastrous consequences in term of morbidity and mortality; 22 cardiac arrests and 10 deaths were reported among the 1,650 Swiss practices during a 5 year period. The occurrence of life-threatening emergencies at the office necessitates, according to the type and place of the practice, the skills of the practitioner and the organization of his practice, the implementation of procedures, equipments (for example room equipped with a defibrillator, respiratory nebulizer, splints, emergency drugs) and specific continuous education programs that should be encouraged and made available to the whole medical corporation.

When physician-expressed uncertainty leads to patient dissatisfaction: a gender study.

CONTEXT: Communication guidelines often advise physicians to disclose to their patients medical uncertainty regarding the diagnosis, origin of the problem, and treatment. However, the effect of the expression of such uncertainty on patient outcomes (e.g. satisfaction) has produced conflicting results in the literature that indicate either no effect or a negative effect. The differences in the results of past studies may be explained by the fact that potential gender effects on the link between physician-expressed uncertainty and patient outcomes have not been investigated systematically. OBJECTIVES: On the basis of previous research documenting indications that patients may judge female physicians by more severe criteria than they do male physicians, and that men are more prejudiced than women towards women, we predicted that physician-expressed uncertainty would have more of a negative impact on patient satisfaction when the physician in question was female rather than male, and especially when the patient was a man. METHODS: We conducted two studies with complementary designs. Study 1 was a randomised controlled trial conducted in a simulated setting (120 analogue patients Analogue patients are healthy participants asked to put themselves in the shoes of real medical patients by imagining being the patients of physicians shown on videos); Study 2 was a field study conducted in real medical interviews (36 physicians, 69 patients). In Study 1, participants were presented with vignettes that varied in terms of the physician's gender and physician-expressed uncertainty (high versus low). In Study 2, physicians were filmed during real medical consultations and the level of uncertainty they expressed was coded by an independent rater according to the videos. In both studies, patient satisfaction was assessed using a questionnaire. RESULTS: The results confirmed that expressed uncertainty was negatively related to patient satisfaction only when the physician was a woman (Studies 1 and 2) and when the patient was a man (Study 2). CONCLUSIONS: We believe that patients have the right to be fully informed of any medical uncertainties. If our results are confirmed in further research, the question of import will refer not to whether female physicians should communicate uncertainty, but to how they should communicate it. For instance, if it proves true that uncertainty negatively impacts on (male) patients' satisfaction, female physicians might want to counterbalance this impact by emphasizing other communication skills.

Physician response to "by-the-way" syndrome in primary care.

BACKGROUND/OBJECTIVE: "By-the-way" syndrome, a new problem raised by the patient at an encounter's closure, is common, but little is known about how physicians respond when it occurs. We analyzed the content of the syndrome, predictors of its appearance, and the physician response. DESIGN/PARTICIPANTS: Cross-sectional study of 92 videotaped encounters in an academic primary care clinic. RESULTS: The syndrome occurred in 39.1% of observed encounters. Its major content was bio-psychosocial (39%), psychosocial (36%), or biomedical (25%), whereas physician responses were mostly biomedical (44%). The physician response was concordant with the patient's question in 61% of encounters if the content of the question was psychosocial, 21% if bio-psychosocial, and 78% if biomedical; 32% of physicians solicited the patient's agenda two times or more in the group without, versus 11% in the group with, the syndrome (P = 0.02). In 22% of the encounters, physicians did not give any answer to the patient's question, particularly (38.5%) if it was of psychosocial content. CONCLUSIONS: "By-the-way" syndrome is mainly bio-psychosocial or psychosocial in content, whereas the physician response is usually biomedical. Asking about the patient's agenda twice or more during the office visit might decrease the appearance of this syndrome.

Workplace adjustment of an expatriate manager: identifying key components from a social capital perspective

Perustaen tutkimuksen kansainvälisen sopeutumisen teoreettiselle rungolle täydentäen sitä sosiaalisen pääoman teorialla, tämä tutkielma tutkii kuinka johtoasemassa oleva ulkosuomalainen luo hyvin toimivan sosiaalisen verkoston hong kongilaisella työpaikallansa. Tutkielma lähestyy aihetta Nahapietin ja Ghoshalin (1998) kehittämän sosiaalisen pääoman kolmen ulottuvuuden mallin avulla. Tutkielmassa kirjallisuudesta haettua teoriaa käytetään tutkimustavarten tehtyjen haastattelujen analysointiapuna. Tutkimalla sosiaalista pääomaa, kansainvälisen sopeutumisen kirjallisuutta, ekspatriootin perinteisiä menestystekijöitä ja guanxia (kiinalaisten henkilökohtaisia siteitä) tämän tutkimuksen teoriaosuus implikoi, että sosiaalisella pääomalla tulisi olla täydentävä rooli kansainvälisen sopeutumisen kirjallisuudessa. Sosiaalisen pääoman kolmen ulottuvuuden mallia käytetään pohjana empiirisen datan analysointiin. Tutkielman empiiriset tulokset osoittavat, että työpaikan sosiaaliseen verkostoon sopeutuminen liittyy exspatriootin kykyyn käsitellä estäviä ja mahdollistajia sosiaalisen pääoman luontiin vaikuttavia tekijöitä. Lisäksi sopeutuminen vaatii exspatriootin tunnistavan kohdemaalle tyypillisiä exspatriootin menestystekijöitä ja ekspatriootinomia tärkeitä henkilökohtaisia ominaisuuksia.

Physician behavioral adaptability: A model to outstrip a "one size fits all" approach

Objective: Based on a literature review, we propose a model of physician behavioral adaptability (PBA) with the goal of inspiring new research. PBA means that the physician adapts his or her behavior according to patients' different preferences. The PBA model shows how physicians infer patients' preferences and adapt their interaction behavior from one patient to the other. We claim that patients will benefit from better outcomes if their physicians show behavioral adaptability rather than a "one size fits all" approach. Method: This literature review is based on a literature search of the PsycINFO1 and MEDLINE1 databases. Results: The literature review and first results stemming from the authors' research support the validity and viability of parts of the PBA model. There is evidence suggesting that physicians are able to show behavioral flexibility when interacting with their different patients, that a match between patients' preferences and physician behavior is related to better consultation outcomes, and that physician behavioral adaptability is related to better consultation outcomes. Practice implications: Training of physicians' behavioral flexibility and their ability to infer patients' preferences can facilitate physician behavioral adaptability and positive patient outcomes.

Prise en charge de la candidose oesophagienne en médecine de premier recours [Management of the esophageal candidiasis by the primary care physician].

La candidose oesophagienne est l'une des infections opportunistes les plus fréquentes chez les patients infectés par le VIH. Ce diagnostic se rencontre également chez des patients sans immunodéficience manifeste. Certains facteurs de risque sont également associés à cette pathologie, tels que les traitements corticoïdes systémiques et inhalés ou les traitements par inhibiteurs de la pompe à protons et les antihistaminiques H2. En l'absence de facteur de risque identifié, un déficit immunitaire primaire devrait être recherché. La prévention de la candidose oesophagienne est basée en premier lieu sur l'identification des facteurs de risque, ainsi qu'un meilleur contrôle de ceux-ci. Cet article présente en détail la physio-pathologie, la clinique et la prise en charge par le médecin de premier recours de la candidose oesophagienne. Nous aborderons également les moyens de prévention de la candidose oesophagienne quand il y a lieu. Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary.